Abstract Background Living with children has been associated with greater risks of SARS-CoV-2 infection, COVID-19 hospitalisation, and COVID-19 death. We examined how these associations varied during 2021–22 and according to the COVID-19 vaccination status of adults. Methods We carried out a population-based cohort study, with the approval of NHS England. Primary care data and pseudonymously-linked hospital and death records from England, between 20 th December 2020 and 21 st February 2022, were used for adults (≥18 years) registered at a general practice on 20 th December 2020. Adjusted hazard ratios (HRs) for SARS-CoV-2 infection, COVID-19 hospitalisation, or COVID-19 death, by presence of children in the household were calculated. Results The cohort included 9,417,278 adults aged ≤65 years and 2,866,602 adults aged >65 years. Adults aged ≤65 years living with children of any age ( versus no children) had greater risks of SARS-CoV-2 infection and COVID-19 hospitalisation (but not COVID-19 death), both when schools were open and closed ( e.g. HR = 1.50, 95% CI:1.49–1.51, for SARS-CoV-2 infection in the ‘Omicron dominant’ period, when schools were open, in adults living with children aged 0–11 years only). These associations also existed for adults aged >65 years, and there was some evidence that older adults living with children also had greater risks of COVID-19 death. Vaccinated adults living with children had greater risks of SARS-CoV-2 infection, but lower risks of COVID-19 hospitalisation and death, than unvaccinated adults not living with children. Conclusions In an era of widespread adult vaccination, adults living with children remained at increased risk of SARS-CoV-2 infection and COVID-19 hospitalisation.